Congress Hears Rx Medicaid Concerns

About 75 executives representing retail pharmacies including those in supermarkets converged on Congress late last month to press their concerns over Medicaid access issues. Fifty of the pharmacy representatives are members of the Food Marketing Institute, Arlington, Va., which organized the two-day along with the National Association of Chain Drug Stores and the National Community Pharmacists

WASHINGTON — About 75 executives representing retail pharmacies — including those in supermarkets — converged on Congress late last month to press their concerns over Medicaid access issues.

Fifty of the pharmacy representatives are members of the Food Marketing Institute, Arlington, Va., which organized the two-day “fly-in” along with the National Association of Chain Drug Stores and the National Community Pharmacists Association, both in Alexandria, Va. They held over 150 meetings with members of Congress and their staffs.

The meetings were arranged to educate members of Congress on two main issues affecting community pharmacy: Medicaid reimbursements and new prescription pad rules.

Of primary concern was the final rule on the Medicaid generic drug reimbursement formula, released on July 6, by the Centers for Medicare and Medicaid Services, Baltimore. The payment method, part of the Deficit Reduction Act of 2005, will use the average manufacturer price (AMP) of drugs to establish a reimbursement formula. However, the calculation of AMP includes, in its average, prices manufacturers give to mail-order pharmacies, which generally accept a lower reimbursement than retail pharmacies can afford.

“The AMP issue is a complex one, such that even members of Congress admitted to not fully understanding the implications,” said Barry Scher, vice president for public affairs and communications for Ahold USA, Quincy, Mass. “I was accompanied by a pharmacist and that was very helpful in addressing the technical aspects of the reimbursement issues we are dealing with.”

The AMP policy is scheduled to take effect in January, trimming $8 billion from Medicaid reimbursement for generic drugs. As a solution, participants in the fly-in encouraged the House to pass the Saving Our Community Pharmacies Act of 2007 (H.R. 3140) and the Senate to pass the Fair Medicaid Drug Payment Act of 2007 (S. 1951).

Both bills require the use of average retail acquisition cost as the basis for Medicaid reimbursement limits on generic drugs.

“We were on the Hill looking for support on the two bills that would more accurately define the AMP to resemble what community pharmacies actually buy their drugs for,” said Cathy Polley, vice president of pharmacy services for FMI. “Each retailer came prepared with examples of the impact the current AMP would have on their pharmacies and customers.”

“There is not one independent or chain pharmacy that won't be impacted in a negative way if the AMP stays as it is,” Scher added.

NEW PRESCRIPTION PAPER

The second topic in the meetings was today's implementation deadline requiring that all Medicaid prescriptions be written on tamper-resistant prescription paper. The provision was part of the Iraq War supplemental appropriations bill, which passed in May. The pharmacies involved were making Congress aware that sufficient time was not given to notify physicians of the new requirement so that they could obtain these pads. Without the pads, pharmacists would potentially have to deny prescriptions to Medicaid patients.

“We were successful with raising the awareness of members of the Kentucky delegation on both issues,” said Jan Gould, senior vice president of the Kentucky Retail Federation, of his meetings. “The members of Congress were very receptive to recognizing the impact of these issues on retail pharmacy, and due to the involvement of FMI, on supermarket pharmacies in particular.”

The collaborative effort among all three organizations provided added awareness on the Medicaid access issues, said NACDS spokeswoman Chrissy Shott. “For example, in a meeting with Jo Ann Emerson [R-Mo.], an original cosponsor of H.R. 3140, there were representatives from all of the diverse aspects of community pharmacy including Wal-Mart, Target, Walgreens, Medicine Shoppe International, Horton & Converse and Hannaford Bros.,” she said.

Although there is a core group of members of both the House and Senate who follows pharmacy issues, FMI was also in contact with offices that make the food industry a priority, said Tim Hammonds, president and chief executive officer of FMI. “Since we work on a broader range [of issues], we were able to multiply the reach of these meetings so that even if some members of Congress choose not to cosponsor the bills in question, they may be more likely to be supportive.”